Saving Time and Money With a Virtual Diabetes Clinic


 

Did you know you could manage your type 2 diabetes without ever leaving your house? For many Americans, managing their type 2 diabetes can seem almost impossible. Whether it’s not having time off to go to doctor appointments, lack of insurance, or not being located near healthcare providers, managing type 2 diabetes may not be a matter of choice but lack of accessibility. Beyond Type 2 sat down with one of the co-founders of 9am.health, Dr. Paul Geevarghese, to talk about how their virtual diabetes clinic is helping people manage their type 2 diabetes and prediabetes from their homes. Listen to or read the interview below to learn more.  

The transcript below has been edited for length and clarity.

Beyond Type 1: I’m Liz Cambron-Kopco and I am a content manager with Beyond Type 1. I’m really excited to talk to Dr. Paul Geevarghese about 9am.health and the programs they have for people with type 2 diabetes. Can you introduce yourself, how you got to this position and how 9am.health got started?

Paul Geevarghese: I’m one of the co-founders here at 9am.health. I’m the chief medical officer. I had two parents that were born in India but immigrated to the U.S., and I had one lucky side to that, my mom was a nurse. And I think I had the ability to live a life of health information privilege, where she was a night nurse, but she knew her way around the healthcare system. I grew up with asthma, so there was a benefit there. 

I don’t think that benefit exists across everybody that has a chronic disease or any other condition and I think it’s really important that we’re able to provide information and care for everyone that needs it.

I had the opportunity to provide some care in Native American reservations out in Gallup, New Mexico. That’s where I really had the opportunity to see the effect of chronic diseases, especially diabetes, in underserved populations. 

Two of my co-founders were from mySugr and they both live with type 1 diabetes themselves. I think it gave us an understanding of the journey of people with diabetes overall. 

Now we have an amazing opportunity to be able to bring the entire experience together, both from the doctor’s side, from the pharmacist’s side, but also the labs and the medications and everything in between there. 

I’ve never heard anything like this before. What is 9am.health and who is it for?

9am.health is a virtual diabetes clinic. We serve people with type 2 diabetes and prediabetes, and we help them get care all the way from the physician visit to the labs to the medications that they’re getting and then also the care in between. 

We really want to be affordable, so it starts at $20 per month and depending on the number of medications and labs that you have, services get layered on top of that.

We are serving people with type 2 diabetes and prediabetes, but we also help with some other conditions that they might have like high blood pressure or high cholesterol. 

When you really think about who is it for and who is it best for? I think anyone that is tired of the existing healthcare system that revolves around diabetes. 

Whether it’s the co-pays that exist across all elements, the wait times to get an appointment, the fact that sometimes you have to take a half day off to do things like getting your labs, anyone that’s tired of that experience. 

Also, anyone that is looking for the right support system, from the pharmacist to the dieticians to the clinicians themselves, and having the resources at their fingertips, that’s exactly where we’ve positioned ourselves.

I know personally, when I have to look for a doctor, it can be months before I can actually be seen as a new patient. So, on average, how long does it take for someone who’s joining 9am.health to see a provider for the first time?

That’s such a good question because I think right now, with the pandemic, that problem’s gotten even worse in terms of how long wait times can be to get in to see a provider, especially if you don’t have established care or you’re a new patient.  

Basically, you come to our website, put in your health information, all the relevant details that are important for us to create a treatment plan, and those treatment plans and consultations happen usually within 24 hours, but in most cases, actually within 15 to 20 minutes. 

That sounds great. What aspects of diabetes management does 9am.health provide?

We have this baseline level of services with the physicians and with ongoing labs and medications. But beyond that, our care team is trained around several different elements of diabetes management. 

From handling your medications to responding to glucose values to understanding your labs, but also very importantly we go one step further into the mental health space to be able to help with coping and diabetes distress

We know there’s a ton of stigmas that exist around type 2 diabetes and we want to debunk that alongside patients to be able to say, “Hey, there are a number of factors that are the reason for your type 2 diabetes and partially genetics, partially other risk factors.”

I think one of the biggest gaps for people living with diabetes is that when they’re not in an appointment face to face with a provider, or screen to screen with a provider, they spend most of their time managing on their own. 

What resources do you provide to help people with self-management after they’ve left their appointments?

When you think about it, when you leave a doctor’s office, you might get some kind of printout that’s directly from the system or a handful of pamphlets, and that’s where we want to change that system as well. 

We have certain resources that are fully within the technology we have. For example, when you get medication and it arrives at your doorstep, you’ll either get a phone call or a message that teaches you a little bit about the medications themselves. It’s really timed with the journey itself.

In addition to that, I’d say our teams themselves are the biggest resource. Having that person to be able to reach out to after a 12-hour shift or during your lunch about your medications, is the biggest resource around this team that’s available at your fingertips. 

The last part of the resources I’ll say is we put a lot of information out through different avenues outside of a pamphlet. You’ll get some videos through our system. On our Instagram accounts, we like to put education out there. 

Part of that is coming back to my earlier point about health education and how it should be accessible and should be a privilege for all and we’re not going to put our education behind a paywall. 

Whether you’re a member or not, you’re going to be able to access that education and get the right trustworthy information out there.

For someone who’s interested in managing their diabetes with 9am.health, is this in place of their primary care provider, or is this supplemental?

I think the easiest way to think about it is if you have a diabetes specialist, sometimes that can coexist with the primary care doctor. In that case, we’ll communicate with those primary care doctors so that we have the same set of information and we’ll try to base things off of that. 

Does someone have to get a referral like they do to see an endocrinologist? Do they need a referral for 9am.health?

For us, no referrals are needed. You actually don’t even need to have insurance to be able to come into our program. You go directly to our website and you can enroll and get matched up through our care system directly through the website itself.

And so you mentioned insurance, is there any aspect that insurance does cover if someone does have insurance or Medicaid or Medicare?

It’s not something we have now, but it’s on our roadmap for the future. In the meantime, we’re trying to keep our programs as affordable as possible, starting at $20 per month. A lot of times that’s cheaper than some of the co-pays that people have. 

You offer at-home testing for A1C, but how do you handle testing for other conditions like high blood pressure and cholesterol?

We have something called a dry blood spot kit that we utilize to get A1C tests. We also use that same test for lipids for your cholesterol levels. We can even do some kidney markers through there as well. 

Actually, we started a partnership with a company called Scarlet Health. We have our first test patient, which I’ve been super excited about, where we’ll actually have a phlebotomist—the person that draws your blood—come to your house.

Obviously, there’s a convenience factor right there in terms of not having to step away from the home or office, but we’ll also be able to get even more labs and markers of your metabolic health through that. 

A big thing that’s changing, I think, is the use of medical technology. Are you able to prescribe continuous glucose monitors (CGMs)?

Right now we’re just in the process of going live with blood glucose monitors because we know blood glucose testing is important. 

At the same time, we know the value of diabetes technology such as CGMs, to be able to show how your body responds to certain foods, how your body responds to certain stressors. 

We think that’s very important also for people with type 2 diabetes.

Currently, the pricing of these CGMs is just not where it needs to be for us to be able to offer this to patients and expect that they can pay it all out of pocket. So it’s actively on our roadmap.

Awesome. Yes, keep it on there because CGMs have been super helpful for a lot of people with diabetes. 

Now we know who 9am.health is for and who can use it, but is it available for people who don’t necessarily speak English or who are hearing impaired?

It’s really important to us to start to offer to all populations, so our care team and our patient care advocate team have Spanish-speaking representatives on each team. We don’t have additional languages than that, but that’s where we’ve started on that side. 

On the hearing impaired side, since a lot of our technology goes through chat, there’s actually a great ability when it comes to hearing-impaired [individuals] to be able to actually do the whole interface through chat as a great solution.

And my last question is how much success have you seen with people using 9am.health to manage their type 2 diabetes?

Our patient care advocate team is talking to individuals every day within the 9am.health ecosystem, and it’s really exciting to hear the feedback that we’re getting.

We have people that live remotely, so maybe an hour, an hour and a half away from a normal town or doctor’s office, that just weren’t getting care before because it’s too far and too expensive with gas prices to actually get out there. 

People that just don’t have time in their lives to be able to manage care and would rather push it off, they’ve been super excited about it. 

And then anyone who’s price conscious or time conscious, they’ve also been really excited about it.

We’re just excited at this point to be able to serve them and provide care to areas where people just don’t get care, areas where they might have just fallen through the cracks of the healthcare system.

It all sounds like a really great resource and an opportunity that is serving a gap that I think has really needed attention for a long time. Thank you for speaking with us and for sharing information. If people want to get more information, where can they go?

They can go to 9am.health, it’ll have all the information there, [including] information on pricing. 

We try to be as transparent as possible and have as many offers as we can to be able to get people on board. Also, feel free to check us out @9am.health for our Instagram. 

 

WRITTEN BY Liz Cambron-Kopco, POSTED 03/22/22, UPDATED 04/21/22

Liz has been living with type 2 diabetes since 2014, but grew up surrounded by it as a first-generation Mexican-American. With a bug for research, Liz pursued a PhD in molecular biology and spent her early career studying insulin signalling in invertebrates to understand how insects' tiny little bodies work. Along with advocating for women and girls in STEM, Liz shares her personal journey with diabetes on her social media platforms to help teach people to become their own advocates. Her passion for advocacy led her to join the Beyond Type 1 team. When she's not advocating, Liz enjoys hiking with her husband and their terrier/schnauzer mixed pup Burberry.